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Home My WebLink About16237 (9) — ��11 �,� CITY OF Di�AMOND BAR I3EPAR�1GtENT OF COMMUNITY 8c DEVELOPM�NT SERVICES � y 2166Q B�Copley Lhive Suite i90 t�)aba-3igsF��>a6i-sii� � �� PRESS M'�" BUILDING PERMIT APPLICATIUN FIRMLY ¢ ADpR{E55�=��]� [ _,v1�'��y�71/ V��"• DATEICATION 3_ �_��I Nt}MB R �-t � �/C � $ ISSUE 'fYPE OCG APN �QT • TftAGT c��2�?a,�__ DATE CONST. GROUP p OWNER �Y -� p ADDRESS �I '�� /�7�+''V�t`�/S'y"7�' ZONING SETBACKS � CITY _ ZIP TEL R�QRT FtW _ � APP4ICANT ,_ TEL SIDE18ttlE STREET RW ❑ � GONTRAC7Qfj 'I � SIDE � q� ADDRESS_�,,�, � �� PROPC?SED USE ( Q CtTY�-_�� ZIP�� TEL�J � � w ARCWENG/ - � dESIGNER �c./ � - �� NQ.DWEL. NO. NO. � ADDfiESS - UNITS STORlES BEpRO(3MS � CITY � ZIF+�``�[��„�j TEL.� � vy �ryf� DESCRIPTiON SC3.FL FACTOR PSF ADJ.AREANALUATIpN � OWNEfl-BUILDEFt DECLARATI(SN 4'G'� SFRIADDIf?EM O I HEREB�AFFIRM UN�ER PENALTV OF PEiW Rv THAT I AM EXEMPT FROM THE CAMTRAGTORS L�� GBF898/CBfptlR W CBISELAWf-0RTHEFOLI.CNVINGREASQN(SEC.]031.SBUSINESSANDPROFESSIONSKADE:ANYGTYOft (n CJ COUNTYVMM7iREW�RES.AAERAiRTOWNSTRUCT,ALTER,IMPROVE,bEMOUSH,OflREPAIR0.NVSTAUG W PdCI0/D6CK W ?URE,PRqq TO ITS ISSUFNCE.ALSO REOUINES THE APPLICANT FOfi SUCM PERMIT TO FILE A 31GNEp � .� STA?EMENT THAT HE OR SNE iS L!GENSED PURSVANi TO THE PR6VISlONS OF TNE CONTRACTQRS il- � CENSE LAW t�pTER B(COMMENCINO WITH SECTION 7006)OF DIVISN7N 7 OF THE BUSINE55 AND PRp• � POpUSpd FESSqNSC4DE70pTHATHEORSHEISE%EMPTTHFREFROMANDTHEBASISFORTHEALLEGE�EXEMP- C7 TpN.ANYVK7[ATIONOFSF:CTlON7031.69YAM`APPIiCANTFORAPEiiMi75UBJECTS7HEAPPUCANTTO Z RB-Fi00f r A CML PENALTY OF NOT ANaRE THAN FIVE HUNDRED DOLLARS(55007.): � OI.ASQYMEROFTNFAROPERNDAMYEMP40YEESWfTNWAGESASTHEIRSOLECAMPENSAT40P1, � �pmmetClHP lY1LL OO TN£W4RK,AF16 t7iE STifllC7URE iS NOt iNTENDEO OR OFFERED iQP SALE(SEC.]OM,BU54 _j NESS ANO PROFESSIONS CDDE:THE CONTRACTOHS LICENSE LAW DOES NOT APPLY TO AN OWNER OF � PROPERTYMhi69U0.DSOFM1PftOVESTHEREON,ANPNMOWESSUGHWORKHlMSELF6ftHERSECFOR � [[ iHNOUGH H�S OR H6R OWN EMPLOVEES,PROYIOEp THAT SUCH IMPqOVEMENTS ApE NOi MTEND€DOR m �� OFFEREDF6qSALE.IFFWWEVER717EBUILDINGORIMPROVEMENiISSOLDWITHINONEVEAROFCOM0.E� z TtIXt,THE oWttEfi�BUitDEfl wNi tEAYE TNE BUF�EN OF PROViNG THAT HE 4R SH6�!6 htt3T eu7t6 aR � IMPHQVEF6RTMEPUHP05EOGSALE). �y,� 0�,�150WNEROFTH4:VRbPEFTY,AMEXCLUSIYELYCANTRACTINGWRHLICEN3EDCONTRACTORS [= TO CQNSTRUCI TNE PRWE_CT($Ev.70tt,BUStNESS ANO GR�F£SS16HS CS3DE'THL:COMTflACTOAS Li� �(y{U0ti0li ADJ.AREA_.,. W CENSELAWDOESNOTMf"�._YTOANOWNEROFAPROPERTVWIMJBUILOSOflIMPROVESTHEREON,AND -��" .... � WNOCONTfUCTSFORSUai�aniEcrswinaacauTancxaa�s;ucEtisEoauAsunn'rTotnEcon'rrua (�UANTITY OESCRIPT36#J FEE � 70RS tlCENSE LAW). ...___.... ❑1 MI 6xEAiM UNDER SEG.�. __ ._8.i P.G.�6R?NtS REASON Q "�r __..�.,- V W � OATE .._ OWNER��. � . U W r+�[ Ut�ENSED CONTRACTORS DECtAFtATiON W CL 1 HEREBYAFFlAM UNOER Pf�NALTY OF PERAJAY THA71 AM UCEN£FU VNDER PftQYtS14N5 Qf CriAPTER � d 9 iCOMMENCWO WfTH SECTfON ioo6}OG OfJi5ic�N 5 QFTHE eUS�NESS AND PP04'ESSIONS Co�E,AND Z 7K MV LICENSE IS Ml FULL FORCE AND EFFECT. - "�n LICENSE CLASS_,�„_��_ LIC.NO. �I�� ._ � ��;��{�---�' + � �' oah � �` _rcorarnncroa a- — — � T W � WORKERS'COAAPENSATI{?N DECIARATidN Q �� i HEREBy/AFFlRM UNOER PENa1TY 4F AER.lV!1Y tXiE OF THE fOI.tOWiNG QECIARATIQNS: Z � �Y��iHAVEAN�WILlM1ANTMNACERTIfICATEbF^.ANSENT705ELF.lNSUREFORwOHKER5 2 �'T CORiPENSATf(1N,AS PROVIOEQ 6'1 SECTI6N 370C OF THE LA$O(i CODE,FOR TH£PERFORMANCfi W OF THE W6RK FOR 1VHICH THI:;PERMIT IS lSSUE�. � �7 //j/y*^ � ^'j�I HAYEMlD WILL MAINTAIN WORKEflS'COMPENSATION INSURANCE.AS RFOIIIRE�BY SECTION n �� 3]00 OFTHQ U1BKli1 COOE,FOR 7HE PERFOqMANCE OF TkfE WbRK F4A WM7CH TH19 PERtATlS iSSUEP.MY WORK�,Q5,`�fXp]MPENSAn4"M�1 INSURANCE CAflt IER ANO POL.ICY NUM6ER ARE: CONSTRUCTII�N jcaw2�[n----�_,,�'La/�� _-y�-��2�-�-f� PLAN REVIEW � _,.. .. ....._� � P011u^Y NUMBER T.' +�., ELECTRIC 4 �'�� -- � �1 i �b � '�1) EarHareEm.uw.EiEoOFr,�aEaMfisFoaoNE��Rx,DqE�oa.l.nRs(slmlcaLEss} PLUMBING _`_ .._......_ Z' I C.ERTiFY iHAT#i TttE PERFORMANCE OG LNE WOFlK FOR WHICN SHiS PEAM�T IS IS^uUEO,1 MECHANICAL �. „_ (� SMN..L NOi EMPI OY ANV PER9nN IN ANV MANNER 50 AS TO BEGOME SUBJECT TO THE � WOHKERS'COMPENSATpNi,AWSOfCAt1FOANVpAN0A9RfEtMATiF�SHOULDB£GOME (NSPEGTIONFEE _�, � SU&IECT T4THE WOAKELiS'COMPENaATION PAOVISION$OF SECTION 3]00 C3F TNE LABOR '' -�� CODE,1 SHALL FOFtTMWITM tiOMPLY WITH THOS ROVISIONS. ISSUANCE �,,,,_� ��,� � -_" p pATE:_, '__ APPLICANL _ '� ., SMIP � �—�.�.�...— ENERGYFIC � i... _� .-- J WARNMIG�FAiI(IqE TO SECU�aC VJORKERS'C4MPENSpTiON COVERAGE IS VNIAWFUL.ANp SHALL BE -- ---� � � $U&IECT PN EMPLOVER 7b CRIMINAL PENAL71E5 AND CIVI4 FMES UP TOONE HUNORED TNf)USAND ENERGY PEFSMIT OOL[ARS{St90,o�0},M1AbDiltf}NTOTtFECAS70FCAMPENSATK?Tl.DAhtAGE'sASPROViDEDFOFiiN ��--� � - �- -- � SECTION3]OBOFTNELABGFCQDE,INTERESi,ANpATTORNEYSFEES. RETENTIQNFEE: �,,. ,,. � CQNSTRUCTfON t,ENpING AGFNCV pRE-ALT FEE: __ �__„ _ � tHER£9YAFfINAiUNDERPENAITY�Ft'[RJlIRYTFkATiH'eflEiSACONSTAUGTiONIEN�WGAGENCY iOR 7HE PEAFOANANCE QF THE WORK FOq WHICH IS PERMIT IS 1551.fED( C.3067,CN CJ. � tENDER'SNAME��++"��_„i�� ,�,__�,.,__ _-� � F_- I.ENQER'SACKTftESS_�`__ �_.__.._.... � f CERTIFY Tt1AT 1 HAVE READ fHiS AFPI.1CATi6NAND 57ATE TliAT TNEA80VE INfOftMAT10N ISCOtiHEGT. TUTAL�EC� (� \�\ � i AC,REE TO CL�MGIY W17N ALL GITY ANp CAUNTY ORpiNANCES ANp STATE lAW5 RELATING f0 BUIL�ING �4� � '�'^�-� �� :ONSTRUCTIpN,AND HEREB'/AUTHORIZE REPRESENTqTIVES OF 7NI5 COUNTV TD ENTER UPON TFIE � ABOVE�MENSIQNED PR6PEP'.'YFOR MSy�4TKNiFVRPOSES. � � �J r ��7�'� �} CQMMENTS... ..� .,.— '� �h�` fL��L - � '--___- . ._._..... _ � d PERMII'fEE NAME(P INTJ .� , `� _�i�t.�,��-- � 2,_�I�--t�/ � �,/? SIGNA E OF PERMITTEE',/ � DATE �'f ^-� � RECPT.NO. �......._ PAID 8Y `��P •J VAIIDATION v �-r µ WHlTE-Qepartment Capy,YEt10W--Finance Copy,Pt14K-ASsassot C�fy,64tDENfl00---FH9 Copy,�REEN--AppiicanYs Gopy �,�g��`i� ��`� �'��'.�%i'�° �� ;��.�.�� ".�� ". c�"�'�= � -. , � �� "� � :��5,,:�� TMa� �v � ��:W�� a�� . �, � � � � � �� b ��"�..^� r �i'�' : _ � ,: , .,. _ � �.. _ z. 7; ,,, _ __ �_� ._ _ _ �� _ __ _ � . _ * � . � ' r'.�.... i, m __ _ . ,__ � �� _ _ ___ _ . � ,. ; z . _ �- ��, _ w . _ , _ __ ,� a � ro � �P`r�R � , _ `r: ._ � . _. . ...� .._ _ _ _ . . — � .� , ,<- � � ; _ _. _ _. ., � �, ekFa.:� ��..��"��.�� _ __ _ _ _._ _. _ _ . _ ' _ . . _ _. .__ _ _ __ _ _ _ . _. _ _ . . __ _ .. __ _. _ � __ _ __ _ _ _ _ _ _ ;�`, ,�� ;s��'s � �p '� a r ._. __ .. .... .. .. . .__ — - _. .. . _ . . .. . �, '��,` `�` .:�. " ra . �'w ,,�, r ,. ,� M1i�.�s.F ,.. � �`��_�� .._. ..._. ...... .__ ._ . . . . . ... .._. _. . .... . .... ... .. .. . . .. s'"� 5 � � %., �k � , � ��¢�,�� ` �� _ _ _ _ _ _ _ _ � T: � � � �` �� ; �'� ,�'`�� t<, �� a � r _ � � .. .. .. ... .... ..... ... . . .... . �� '^��;�' �'�'��,� � � ,s"�s� "��`�,��'��, "`�,��r�� _ � �;��:�%�� ,�� f ��''� � � ' ,�"�"gbs"'= _ CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E'Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION PRESS FIRMLY JOBSITE ADDRESS 2-4-372 el�yj,/ APN LOT TRACT L5 226 OWNER,-Y x ADDRESS 7/S2* CITY ZIP TEL. APPLICANT TEL. CONTRACTO- 1,tXf ADDRESS�L /Sy ZG CITY-14 E ZIPL TEL ARCWENG/_ DESIGNER 1/- ADDRESS . CITY ZIPS�Q TEL.<- OWNER-BUILDER DECLARATION le' I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE:ANY CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT,ALTER. IMPROVE,DEMOLISH,OR REPAIR ANY STRUC- TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW(CHAPTER B (COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO. FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP. TION.ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(5550).): ^ I,AS OWNER OF THE PROPERTY,OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. 7044,BUSI- NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE IF HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TION.THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). ^I.AS OWNER OF THE: PROPERTY,AM EXCLUSIVELY CONTRACTlNG WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 7044, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LI- CENSE LAW DOES NOTAPP'._Y TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). 0 I AM EXEMPT UNDER SEC. &P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE AND EFFECT. LICENSE CLASS LTC. N0. DATE,4a/_•P'(CONTRACTOR WORKERS'COMPENSATION DECLARATION I HERE.AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: .AVE AND W ILL MANTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORK'COMPENSATION INSURANCE CAR ER AND POLICY NUMBER ARE CARRIER CLf �� POLICY NUMBER I�J7 Y�// �(TS SECTR71-NEED NOT BOFTIEPERMIT IS FOR ONE HIJDRED DOLLARS($100)OR LESS) I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS'COMPENSATION LAWS OF CALIFORNIA AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE,I SHALL FORTHWITH COMPLY WITH THOS ROVISIONS. DATE: APPLICANT: .�- WARNING: FAILURE TO SECUIE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. CONSTRUCTlON LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH IS PERMIT IS ISSUED(EC. 3087,CIV C.). LENDER'S NAME�i LENDER'S ADDRESS 1 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT 1 AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INS CTION PURPOSES. PERMITTEE NAME TI SIGNA E OF PERMITTEE/DATE APPLICATION 3_ 1_ PERMIT )I 2 /C \ DATE 1 N # UMBER U' ISSUE TYPE OCC DATE CONST.GROUP ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW^ SIDE^ PROPOSED USE Lea N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM U) Garage/Carport W Patio/Deck LL PooVSpa 0 Re-Roof Z Q Commercial m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U H W CJ Z CL Z w CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES U L\� 'C COMMENTS NO C L RE PT . PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy. PINK-Assessor Copy,GOLDENROD--File Copy,GREEN-Applicant's Copy